Peters M G, Shouval D, Bonham A, Vierling J M, Lok A S
University of California at San Francisco, USA.
Semin Liver Dis. 2000;20 Suppl 1:19-24.
Recent advances in prophylaxis and treatment of hepatitis B virus (HBV) infection after liver transplantation have improved the outcome of liver transplantation for hepatitis B. Currently, the long-term use of hepatitis B immune globulin (HBIG) and/or nucleoside analogues are the only effective therapies to prevent or ameliorate HBV recurrence in liver transplant patients. However, they are very expensive, and breakthrough infections due to resistant HBV mutants are not infrequent. New strategies are being sought to decrease the risks of breakthrough infection and to increase the cost-effectiveness of liver transplantation for hepatitis B. Vaccination to prevent de novo infection is strongly recommended before transplantation, despite a decreased response in this immunosuppressed population. Adoptive transfer of immunity with such therapies as bone marrow or cytotoxic T lymphocyte transplants or xenotransplantation of an organ from a donor, which is not susceptible to infection by HBV may be effective in preventing or treating recurrent HBV posttransplantation. In addition, gene therapies and use of nucleoside and nucleotide analogues to disrupt various stages of the HBV life cycle may prevent or slow viral replication or assembly of the virus. Ultimately, the most effective therapy for the prevention of recurrent hepatitis B after liver transplantation will involve a combination of HBIG with one or more of the new antiviral agents.
肝移植后乙型肝炎病毒（HBV）感染预防和治疗方面的最新进展改善了乙型肝炎肝移植的预后。目前，长期使用乙型肝炎免疫球蛋白（HBIG）和/或核苷类似物是预防或改善肝移植患者HBV复发的唯一有效疗法。然而，它们非常昂贵，并且由耐药HBV突变体引起的突破性感染并不罕见。人们正在寻求新的策略来降低突破性感染的风险，并提高乙型肝炎肝移植的成本效益。尽管在这个免疫抑制人群中反应有所降低，但强烈建议在移植前进行预防新发感染的疫苗接种。通过骨髓或细胞毒性T淋巴细胞移植等疗法进行免疫过继转移，或移植来自不易感染HBV的供体的器官进行异种移植，可能对预防或治疗移植后复发性HBV有效。此外，基因疗法以及使用核苷和核苷酸类似物来破坏HBV生命周期的各个阶段，可能会预防或减缓病毒复制或病毒组装。最终，预防肝移植后复发性乙型肝炎的最有效疗法将涉及HBIG与一种或多种新型抗病毒药物的联合使用。
